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Published on: March 22, 2024
Association between low-density lipoprotein cholesterol level and mortality in patients with cardiogenic shock: a
Jiali Jin1, Zhewei Shi1, Xiaomin Pang2
1Department of Cardiology, Zhuji People's Hospital of Zhejiang Province, Zhuji, China.
Insights
Higher low-density lipoprotein cholesterol (LDL-C) levels are linked to improved survival rates in patients experiencing cardiogenic shock (CS). This finding suggests LDL-C may serve as a prognostic biomarker in CS patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Biomarker Research
Background:
- Inflammation is central to cardiogenic shock (CS) pathophysiology.
- Low-density lipoprotein cholesterol (LDL-C) is an inflammation biomarker with prognostic value in various diseases.
- The prognostic role of LDL-C in CS requires further elucidation.
Purpose of the Study:
- To investigate LDL-C as a predictive biomarker for mortality in patients with cardiogenic shock.
- To assess the association between LDL-C levels and survival outcomes in CS.
Main Methods:
- Retrospective analysis of critically ill CS patients from the MIMIC-III database.
- Multivariate Cox regression models were used to adjust for confounders.
- Patients were categorized based on LDL-C levels (<1.8 mmol/L vs. ≥1.8 mmol/L).
Main Results:
- Higher LDL-C (≥1.8 mmol/L) was associated with significantly reduced in-hospital (HR 0.66) and 28-day mortality (HR 0.61) in CS patients.
- Patients with LDL-C ≥1.8 mmol/L showed improved in-hospital (HR 0.32) and 28-day survival (HR 0.51).
- This association persisted in patients with acute coronary syndrome (ACS) but was not significant in non-ACS subgroups.
Conclusions:
- Elevated LDL-C levels correlate with improved survival in cardiogenic shock patients.
- LDL-C may serve as a prognostic indicator for mortality in CS.
- Further validation through randomized controlled trials is warranted.
Aims:
Inflammation plays a key role in the pathophysiology of cardiogenic shock (CS). Low-density lipoprotein cholesterol (LDL-C) is a biomarker of inflammation and is used to predict prognostic outcomes of several diseases. The primary purpose of this study was to evaluate if LDL-C can be used as a biomarker to predict the mortality of CS.
Methods And Results:
Records of critically ill patients with CS were identified from the Medical Information Mart for Intensive Care III database. A multivariate Cox regression model was employed to adjust for imbalances by incorporating parameters and potential confounders.A total of 551 critically ill patients with CS were enrolled for this analysis, including 207 with LDL-C <1.8 mmol/L and 344 with LDL-C ≥1.8 mmol/L. Results of multivariate Cox regression models found that higher concentration of LDL-C (LDL-C ≥1.8mmol/L) was associated with a reduced risk of in-hospital mortality (HR 0.66, 95% CI 0.50 to 0.87; p=0.003) and 28-day mortality (HR 0.61, 95% CI 0.46 to 0.80; p=0.002) LDL-C in patients with CS. Patients with LDL-C ≥1.8 mmol/L were independently associated with improved in-hospital survival (HR 0.32, 95% CI 0.20 to 0.52, p<0.001) and 28-day survival (HR 0.51, 95% CI 0.33 to 0.73, p=0.002) compared with patients with LDL-C <1.8 mmol/L. The impact of LDL-C on in-hospital mortality and 28-day mortality persisted in patients with acute coronary syndrome (ACS) and was not statistically significant in the non-ACS subgroup.
Conclusions:
Our study observed that increased LDL-C level was related with improved survival in patients with CS, but not with improved outcomes in patients with uncomplicated ACS. The results need to be verified in randomised controlled trials.
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